Is 2012 The Year Of Online Patients?

Meaningful Use programs, healthcare reform, and the public's love of mobile devices could add up to patients finally getting fully involved in their own care.

Sticking with New Year's resolutions is still top of mind for many folks. No doubt many are looking to the new smartphones, iPads, and health-related apps that Santa delivered to help fulfill those resolutions. So could 2012 be the year of tech-enabled patient engagement?

A New Year's resolution may only be the tip of the iceberg. Meaningful use and accountable care organizations will encourage patient engagement, according to Patti Brennan, a professor of nursing and engineering at the University of Wisconsin-Madison and national program director of Project HealthDesign.

The program, launched several years ago and funded by the Robert Wood Johnson Foundation, explores ways to improve personal health records by capturing and integrating patient recorded data.

"With MU and ACOs, it begins to really matter what happens to patients when they're not there" in the clinical setting, said Brennan in an interview with InformationWeek Healthcare.

First, the HITECH Act's $27 billion-plus Meaningful Use program has more clinicians rolling out systems that digitize patient data. Also, Stage 2 and Stage 3 are expected to require more electronic interaction between patients and clinicians, she said.

In order for these organizations to work, doctors will have to convince patients to get more involved in their own healthcare--including using their own data to keep better tabs on their illnesses. In fact, payments tied to better patient outcomes--helped by smarter use of patient data-- is a big driver for more healthcare providers to participate in patient engagement initiatives, Brennan said.

Yet, with so much on doctors' plates as it is—"most doctors don't want a tsunami of new data" added to EHR and other systems from their patients' home health monitoring or wellness devices, said Brennan. That's especially true since most of this data doesn't warrant emergency care.

However, when there is an issue that requires immediate attention, Project HealthDesign teams have found that patients' monitoring data can be successfully sent to or shared with other clinicians, such as triage nurses or case managers, who can often help facilitate earlier intervention, or give feedback to patients without overwhelming doctors.

Patients who do have chronic conditions "want to have an easy way of monitoring themselves without overdoing it," because when they are tracking too many things or too frequently, "they end up giving up the monitoring within a few weeks or months," said Brennan.

But to date, getting patients more engaged in their healthcare--and using IT to do so--has been a challenge, as was evident in the closing late last year of Google Health, a personal health record service.

"At Google, we learned that patient engagement is very difficult," said Missy Krasner, a former Google Health executive, who was previously a communications director to Dr. David Brailer while he was the first National Coordinator of Health IT, for president George W. Bush. Krasner has just joined venture capital firm Morgenthaler Ventures as its new executive in residence.

Krasner will help Morgenthaler identify promising health IT ventures in which to invest. Right now, developers of patient-provider engagement products rank among the "interesting" contenders, she says. A big challenge in patient-provider engagement is "staying in touch between episodes of care," said Krasner.

Tools including mobile applications that make it easy for patients to securely send relevant information to providers, even via simple text messages, are promising, she says. So too are platforms that can bring together all the data that gets generated by home health monitoring devices, so patients with chronic illnesses don't have to visit several different medical device portals to see the sum of their health data, Krasner said.

Krasner thinks patient engagement tools can get more credibility--and possibly more regular use--when they are provided by a clinician. "Getting something from a doctor is probably the best bet" in raising the chances that the application or device will be used by the patient, she said.

For its part, Project HealthDesign currently has five project teams exploring how the capture, collection, and sharing of patient-recorded data can improve interactions between patients and clinicians and improve outcomes.

The goal: See how patients can collect, store, and use observations of daily life (ODLs) that can help clinicians make decisions and give patients insights into their own health, said Brennan.

"ODLs serve as personal health sentinels," said Brennan. By collecting ODLs, individuals can discover clues about health that could prompt behavior changes.

For instance, in one Project HealthDesign project, patients suffering from Crohn's, a progressive digestive disease, use iPads and other mobile devices to self track pain, energy levels, and other symptoms.

Patients can share summaries of these ODLs with their doctors during or in between office visits. But the collection of these ODLs may also help patients recognize patterns involving certain foods or situations that might foreshadow or contribute to unpredictable disease flare-ups.

"ODLs arise from the patient’s experience, not the clinician’s perception. ODLs may be the most truly patient-centered type of personal health data," she said.

Other Project HealthDesign projects include efforts that use smartphones, cell phones, other mobile devices, and sensors to collect ODL data from asthma patients, new moms of high-risk infants, elderly patients at risk for dementia, and low-income teens managing obesity.

By the summer, all five Project HealthDesign projects are expected to wrap up.

Since the Project HealthDesign program was launched several years ago, there have been about a dozen team efforts aimed at "exploring the power and potential of next generation personal health records," she said.

Over that time, the concept of PHRs has evolved and is "being rethought of as not a binder of patient records but rather a platform for action," Brennan said.

When are emerging technologies ready for clinical use? In the new issue of InformationWeek Healthcare, find out how three promising innovations--personalized medicine, clinical analytics, and natural language processing--show the trade-offs. Download the issue now. (Free registration required.)

Gil, I completely agree with all of your statements. It's kind of ironic in a way that people used to completely trust their doctor with their care, although it is difficult for physicians to speak to patients in a way that they understand their condition. Now consumers get more information about health from the Internet, but they don't understand it and take it to the doctor for interpretation.

As just an example, In informed consent for clinical trials, the average reading level is 11.1 grade, while the average American reading level is grade 8.

But the point is that Health Literacy and education would be helpful for the whole population; doctors that can speak at an average level; information that is explained to the average American would all go toward the online patient engagement.

The problem identified is with consumer motivation. ItGÇÖs not surprising, however, that consumers would not be interested in providing health information without the ability to also participate in decisions that influence their health.

This is no different to other areas of our life. For example, online banking would not be as popular if all one could do is check their account balance without being able to take action - transfer money, pay bills, invest, etc. Viewing products without the ability to actually make a purchase would make online shopping less attractive to consumers.

Therefore, it is important that (1) consumers are given the opportunity to access their (online) information and participate in decisions regarding their care; (2) consumers are provided with education to improve Health Literacy - making them better healthcare consumers (without making them doctors); and (3) education and regulation is used to encourage healthcare providers to include consumers in a collaborative care process.

Patient engagement in any area is a test in psychological behavior. Physicians are being driven by force, and vendors through incentives to develop and or use EHRs, but the ultimate user, the patient has no such incentive.

Fear of the Internet, fear of information being used for wrong purposes, the difficulty for many to use the software or web sites or just the tedium of staying on top of yet another technology in their life. Google Health noticed it is difficult to keep patients engaged between episodes of care. That would seem normal, unless you have a chronic condition.

The above example, with a targeted disease, is a great start. But blanketing the population, maybe more difficult.

With the HITECH incentives peaking in 2012 I expect it to be a big year for implementing solutions, however the Meaningful Use patient engagement objectives really ramp up in Stage 2 and 3, so it may be a couple of years before we see wide spread adoption and use, but it's a step in the right direction.

I also agree wholeheartedly with with Missy Krasner's statement about patient engagement tools having more credibility when connected to and coming from the provider. A good example of this is Navigating Cancer, a patient portal for oncology practices that provides patient engagement tools and resources under the clinic's brand.